Provider Demographics
NPI:1194456038
Name:NADEEN LUCERO SOEDERBAUM MD PLLC
Entity Type:Organization
Organization Name:NADEEN LUCERO SOEDERBAUM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEEN
Authorized Official - Middle Name:LUCERO
Authorized Official - Last Name:SOEDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-823-4290
Mailing Address - Street 1:6017 LAKEHURST CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1025
Mailing Address - Country:US
Mailing Address - Phone:817-823-4290
Mailing Address - Fax:
Practice Address - Street 1:903 MEDICAL CENTRE DR STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4754
Practice Address - Country:US
Practice Address - Phone:682-220-9646
Practice Address - Fax:580-297-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care